My dad is taking medicines for diabetic and hypertension from past 20yrs. Due to skin itching he has taken blood test before 1 week.It was 325mg/dl blood sugar and 6.3 mg/dl of creatinine. After strict diet control and increase of insulin to 15 from 10 Unit, blood sugar is 75mg/dl and creatinine is 5.8mg/dl. I know that creatinine increase is an evidence of renal failure. Please advice to improve his kidney function.

- assessing your dad's case, i noticed that he is on insulin therapy for the management of his diabetes, suggessting that he is a type 1 diabetic patient. based on the blood glucose level of 75, which is within the normal recommended range, the dose of the insulin seems to be appropriate. usually frequent monitoring of blood glucose before and after meals help us in deciding on an insulin schedule and the type of insulin (short acting, intermediate, and long acting, depending on each patient's case).

- the second key point is blood pressure. you noted that your father's blood pressure is 160/100. this is a high reading, and with the different medications your dad is recieving , amlodipine and diuretics, it is possible that your dad needs to be on additional medication, or the whole therapy needs to be assessed.

the target goal for blood pressure is patients with diabetes is 135/80 and your dad bp is 160/100 suggessting that your dad is not at his target goal. this is important because as i mentioned in my introduction, it is important to control both blood pressure and blood sugar to prevent further kidney damage.

ACE inhibitors are very effective class of drugs to treat hypertension and it is usually first line therapy for patients with diabetes. this class has been shown to provide a nephroprotective effect, that is a renal protective effect. I wonder if your dad has tried these agents before, such as lisinopril, ramipril, accupril, etc. or even ARBs (angiotensin receptor blockers like irbesartan, candasartan, etc).

one more thing i want to point out to you, since you requested detailed answers :) diuretics are great agents and first lines for the management of hypertension, but they can increase blood sugar via an unknown mechanism. Now this is not a reason to perclude their use in hypertension and diabetes, but it is something that one need to be aware off.

overall, hydration is always very important, but i highly recommend tight glucose and blood pressure control for your dad to prevent further exacerbations of his renal function. worsenning of renal function is a consequence of diabetes and hypertension; we can not eliminate it , but we can for sure help preventing it from getting worse.

so it seems to me that the doctor took out the diuretics, and your dad currently is only on amlodipine for treatment of hypertension. I wonder how is your father's blood pressure doing on amlodipine alone.

itching is very common and often present in patients with kidney /renal disease. In addition, most of patients treated with dialysis complain of itching of the skin during or after dialysis sessions. it is believed that uremic toxins that arent removed from the blood by dialysis sessions could contribute to the itching of the skin.

The problem can also be related to high levels of parathyroid hormone (PTH), and it is a common in kidney failure. there is no cure for itching, but the fact that your dad is on calcitriol (a drug used for managment of hypocalcemia in patients with chronic renal failure), this drug also help reduce elevated leves of parathyroid hormones, and therefore will help reduce the itching.

if itching continues to be a problem, you can use antihistamines like benadryl (diphenhydramine) or capsaicin topical cream.

as for drinking, hydration is important. in deed increasing water intake and decreasing salt intake help in the management of both kidney failure and hypertension. fluid restrictions is important for patients with heart failure; that is why doctors use alot of duiretics in these patients. based on your case presentation, your father does not have heart failure, but the fact that the doctor took out diuretics from his medication regimen, you don't want him to ingest too much fluids (> 1.5-2 L). With the absence of diuretics, your dad wont be able to get rid easily of the fluid build up in his system until he has a dialysis session.

Thanks a lot Doctor for giving all the valuable suggestion.I would like to clarify that whether we need to consult the doctor again for any additional medication.I will update about any change in his treatment if any.

Yesterday I have taken him to another doctor due to swelling in legs and also for having Shanvac(Hepatis -B) vaccine which was prescribed by his regular doctor.He asked us to take two injections(Venofer and Espogen 4000IU) yesterday itself and we did that. Doctor also asked my dad to stop insulin and change to tablets for sugar control since insulin now a days caused him hypoglycemia(dad was taking 15 unit each morning nut now a days it is causing hypoglycemia).I fear to change the medicine without the knowledge of our regular doctor. Is it Ok to change?. And this doctor asked us to create AVF next week itself and to be prepared for Dialysis. I would like to know about the effectiveness of renal transplant and its aftermath. What all thing we should take care. How much will be the cost and after transplant cost. What are the complications about rejection. I have heard about stem cell technique for that?